Provider Demographics
NPI:1093049736
Name:MATHEW, RICIA J (ARNP)
Entity Type:Individual
Prefix:
First Name:RICIA
Middle Name:J
Last Name:MATHEW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RICIA
Other - Middle Name:J
Other - Last Name:PARAMBIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 GOLF MEADOW BLVD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7297
Mailing Address - Country:US
Mailing Address - Phone:813-643-6595
Mailing Address - Fax:
Practice Address - Street 1:1201 ORIENT RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-3325
Practice Address - Country:US
Practice Address - Phone:813-247-8972
Practice Address - Fax:813-247-8975
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3343182363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3055205Medicaid